What this is about
When the baby’s head comes out, the surrounding skin (also called ‘perineum’) often stretches and tears a little. For most women, these tears are minor and heal quickly on their own. Occasionally, a deeper tear can happen, called a 3rd or 4th degree tear. These are uncommon but need to be repaired with surgery and take longer to heal. In 2024, around 6 in every 100 people giving birth in Lothian had a 3rd or 4th degree tear, compared with 4 in 100 across Scotland. Because our rate was higher than the Scottish average, we made reducing tears a priority and started a specific improvement programme in 2025.
What we are doing
- Your midwife will offer to show you how to massage your perineum during pregnancy and explain how this can help reduce the chance of having a tear when giving birth
- During labour, your midwife will explain what techniques can be used to reduce the chance of tearing when your baby is born.
- If you suffer a deeper tear, you will be offered follow-up care, including physiotherapy and access to specialist support clinics.
- Our approach follows national best practice, known as the OASI Care Bundle, which is supported by the Royal College of Obstetricians and Gynaecologists (RCOG). Find out more about the OASI Care Bundle on the RCOG website.
How this helps you
By focusing on prevention, fewer women experience a deeper tear. If one does happen, it is identified quickly, repaired effectively, and followed up with the right support to aid recovery.
Our progress
Since the start of our improvement work, we have already seen a reduction from 6 in every 100 women to now 5 in 100 women giving birth in Lothian experiencing a 3rd or 4th degree tear — and we are aiming to reduce this further to less than 4 in 100 women by March 2027, in line with the national average.
What you can do
When talking about your preferences for labour and birth, ask your midwife about the different techniques that can be offered to you to help reduce tearing.
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